# Towards Reliable Medical LLMs: Benchmarking and Enhancing Confidence Estimation of Large Language Models in Medical Consultation

arXiv: https://arxiv.org/abs/2601.15645 · HTML: https://mlsanity.com/paper/2601.15645/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 36 of its 66 references that are in the map.
- First posted on arXiv 22 Jan 2026.

## Builds on (most cited first, 30 of 36)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Language Models (Mostly) Know What They Know](https://mlsanity.com/paper/2207.05221/) (2022)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [Can LLMs Express Their Uncertainty? An Empirical Evaluation of Confidence Elicitation in LLMs](https://mlsanity.com/paper/2306.13063/) (2023)
- [Semantic Uncertainty: Linguistic Invariances for Uncertainty Estimation in Natural Language Generation](https://mlsanity.com/paper/2302.09664/) (2023)
- [Just Ask for Calibration: Strategies for Eliciting Calibrated Confidence Scores from Language Models Fine-Tuned with Human Feedback](https://mlsanity.com/paper/2305.14975/) (2023)
- [Teaching Models to Express Their Uncertainty in Words](https://mlsanity.com/paper/2205.14334/) (2022)
- [How Can We Know When Language Models Know? On the Calibration of Language Models for Question Answering](https://mlsanity.com/paper/2012.00955/) (2020)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [Generating with Confidence: Uncertainty Quantification for Black-box Large Language Models](https://mlsanity.com/paper/2305.19187/) (2023)
- [Out-of-Distribution Detection and Selective Generation for Conditional Language Models](https://mlsanity.com/paper/2209.15558/) (2022)
- [Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation](https://mlsanity.com/paper/1911.13273/) (2019)
- [Fact-Checking the Output of Large Language Models via Token-Level Uncertainty Quantification](https://mlsanity.com/paper/2403.04696/) (2024)
- [Shifting Attention to Relevance: Towards the Predictive Uncertainty Quantification of Free-Form Large Language Models](https://mlsanity.com/paper/2307.01379/) (2023)
- [Quantifying Uncertainty in Answers from any Language Model and Enhancing their Trustworthiness](https://mlsanity.com/paper/2308.16175/) (2023)
- [A Survey on Uncertainty Quantification of Large Language Models: Taxonomy, Open Research Challenges, and Future Directions](https://mlsanity.com/paper/2412.05563/) (2024)
- [Uncertainty Quantification and Confidence Calibration in Large Language Models: A Survey](https://mlsanity.com/paper/2503.15850/) (2025)
- [DDXPlus: A New Dataset For Automatic Medical Diagnosis](https://mlsanity.com/paper/2205.09148/) (2022)
- [SafeBench: A Safety Evaluation Framework for Multimodal Large Language Models](https://mlsanity.com/paper/2410.18927/) (2024)
- [Mutual Information Alleviates Hallucinations in Abstractive Summarization](https://mlsanity.com/paper/2210.13210/) (2022)
- [A Review of Uncertainty Estimation and its Application in Medical Imaging](https://mlsanity.com/paper/2302.08119/) (2023)
- [Look Before You Leap: An Exploratory Study of Uncertainty Measurement for Large Language Models](https://mlsanity.com/paper/2307.10236/) (2023)
- [AGENTSAFE: Benchmarking the Safety of Embodied Agents on Hazardous Instructions](https://mlsanity.com/paper/2506.14697/) (2025)
- [MediTOD: An English Dialogue Dataset for Medical History Taking with Comprehensive Annotations](https://mlsanity.com/paper/2410.14204/) (2024)
- [Rainproof: An Umbrella To Shield Text Generators From Out-Of-Distribution Data](https://mlsanity.com/paper/2212.09171/) (2022)
- [Probabilistic Medical Predictions of Large Language Models](https://mlsanity.com/paper/2408.11316/) (2024)
- [Where MLLMs Attend and What They Rely On: Explaining Autoregressive Token Generation](https://mlsanity.com/paper/2509.22496/) (2025)
- [SafeMobile: Chain-level Jailbreak Detection and Automated Evaluation for Multimodal Mobile Agents](https://mlsanity.com/paper/2507.00841/) (2025)
- [The challenge of uncertainty quantification of large language models in medicine](https://mlsanity.com/paper/2504.05278/) (2025)

## Abstract (arXiv)

Large-scale language models (LLMs) often offer clinical judgments based on incomplete information, increasing the risk of misdiagnosis. Existing studies have primarily evaluated confidence in single-turn, static settings, overlooking the coupling between confidence and correctness as clinical evidence accumulates during real consultations, which limits their support for reliable decision-making. We propose the first benchmark for assessing confidence in multi-turn interaction during realistic medical consultations. Our benchmark unifies three types of medical data for open-ended diagnostic generation and introduces an information sufficiency gradient to characterize the confidence-correctness dynamics as evidence increases. We implement and compare 27 representative methods on this benchmark; two key insights emerge: (1) medical data amplifies the inherent limitations of token-level and consistency-level confidence methods, and (2) medical reasoning must be evaluated for both diagnostic accuracy and information completeness. Based on these insights, we present MedConf, an evidence-grounded linguistic self-assessment framework that constructs symptom profiles via retrieval-augmented generation, aligns patient information with supporting, missing, and contradictory relations, and aggregates them into an interpretable confidence estimate through weighted integration. Across two LLMs and three medical datasets, MedConf consistently outperforms state-of-the-art methods on both AUROC and Pearson correlation coefficient metrics, maintaining stable performance under conditions of information insufficiency and multimorbidity. These results demonstrate that information adequacy is a key determinant of credible medical confidence modeling, providing a new pathway toward building more reliable and interpretable large medical models.